Solution-focused brief therapy: a review of the outcome research

Solution-focused brief therapy (SFBT) is a new and increasingly used therapeutic approach that focuses on helping clients construct solutions rather than solve problems. The approach evolved in a clinical context amid many anecdotal reports of success from both therapists and clients, but it has not been subjected to controlled empirical testing until very recently. In this article we critically review all of the controlled outcome studies of SFBT to date (N = 15) to assess the extent to which SFBT has received empirical support. Five studies were well-controlled and all showed positive outcomes--four found SFBT to be better than no treatment or standard institutional services, and one found SFBT to be comparable to a known intervention: Interpersonal Psychotherapy for Depression (IPT). Findings from the remaining 10 studies, which we consider moderately or poorly controlled, were consistent with a hypothesis of SFBT effectiveness. We conclude that the 15 studies provide preliminary support for the efficacy of SFBT but do not permit a definitive conclusion. Our critique highlights areas where methodology in future studies can be strengthened to provide more conclusive evidence of SFBT efficacy.     

A Microanalytic Case Study of the Utilization of ‘Solution-Focused Problem Talk’ in Solution-Focused Brief Therapy

Abstract

Solution-focused therapy (SFBT) is a popular therapeutic approach among family therapists. However, disputes about SFBT still arise, especially on problems. This study examines the function of problem talk in SFBT by using a microanalytic case study method. As a result, three categories were found: Eliciting, clarifying, and acknowledging problems. The problem talks initiated by the SF therapist showed a pattern associated with the solution talk and served as preliminary steps to be connected to the following solution talks. The results indicate that solution building is constructed not only through solution talk, but also through ‘solution-focused problem talk.’     

Love in therapy: A qualitative study of how clients perceive their therapists’ emotions

Relevant literature on attachment theory has explored the importance of emotional experience inside the therapeutic setting, highlighting that the active engagement of the therapist with the client is necessary in the process of change. However, less is known about the clients’ perception of the therapists’ emotional expression during a session. In this qualitative study, we used narrative thematic analysis to examine 10 semi-structured interviews with clients in an enriched systemic therapy approach. Focusing on the similarities of clients’ experiences, what emerged from the interviews were specific ‘perceived emotions’ and the related facial expressions of the therapists that were given attention by the clients. Based on our findings, six emotional themes were identified and are considered prominent: (i) ‘excitement’, (ii) ‘calmness’, (iii) ‘affection’, (iv) ‘empathy’, (v) ‘anger’ and (vi) ‘sadness’. Also, the analysis revealed two distinct functions of the expression of the therapist’s emotions: (i) they are an essential part of the therapeutic relationship and, (ii) they provide clients with alternative ways of experiencing emotions and motivate them to change. Therapists are invited to recognize the importance of their own emotional and facial expression in therapy considering it a form of self-disclosure. Suggestions for further research are also provided.     

The relationship between therapeutic engagement,cognitive errors,and coping action patterns: An exploratory study

Aim: This exploratory study examined the relationship between clients’ involvement in therapy and their cognitive errors (CE) and coping action patterns (CAP). Method: Therapy sessions from N = 26 clients were rated for CE and CP using the CE and CAP methods. Client involvement was measured with the Positive and Negative Affect Schedule, as well as the . Results: The CEs’ ‘magnification of the negative or minimisation of the positive’ and ‘labelling’ were associated with measures of affective therapeutic engagement. The coping styles ‘negotiation’, ‘opposition’, ‘submission’, ‘isolation’, ‘support seeking’, ‘information seeking’, ‘delegation’, and ‘escape’ were found to be associated with affective and behavioural dimensions of therapeutic involvement. Conclusions: These findings provide preliminary supporting evidence that CE and CP are related to the extent to which clients engage in the work of therapy. Implications for researchers and therapists are discussed.     

‘It’s about having exposure to this’: investigating the training needs of therapists in relation to the issue of anomalous experiences

Two focus groups, consisting of six participants each, were conducted to explore the training needs of therapists when working with clients reporting anomalous experiences (AEs). AEs are those that ‘depart from our own familiar personal experiences or from the more usual, ordinary, and expected experiences of a given culture and time’ [Braud, W. (2012). Health and well-being benefits of exceptional human experiences. In C. Murray (Ed.), Mental health and anomalous experience (pp. 107–124). Hauppauge, NY: Nova Science Publishers.]. A thematic analysis revealed four themes: ‘Quite often we get taken by surprise because it’s a subject we don’t talk about’, ‘It’s just having this in our vocabulary’, ‘Demystifying and valuing AEs as normal human experiences’ and ‘To ask or not to ask?’. Most of the participants felt that they were unequipped to work with clients reporting AEs and suggestions were made for overcoming this.     

Counselling in general practice: Clients' perceptions of significant events and outcome

An investigation of clients' perceptions of the change process and outcome of counselling in primary care is presented. Significant events were identified by 51 clients post-session for a mean of 4.7 counselling sessions. Outcome was assessed by clients, through their perceptions of goal attainment and change in quality of life from pre-to post-counselling. Four-hundred-and-nine events were categorized by use of the Therapeutic Impact Content Analysis System (TICAS) and a content analysis system was created to categorize clients' goals. Results showed that ‘reassurance’, ‘problem solution ’, ‘insight’ and ‘involvement’ impacts were reported most frequently by clients. No category of significant events was related to change in quality of life. For 11 clients who set goals in the ‘expression’ category, more ‘reassurance’ and fewer ‘problem solution’ impacts were related to attainment of ‘expression’. Some suggestions are made for the lack of significant relationships with overall measures of outcome and it was suggested that more qualitative analysis of the process of outcome is needed.     

Revisiting a meta-analysis of helpful aspects of therapy in a community counselling service

This small scale mixed methods study examines helpful events in a community counselling setting, categorising impacts of events according to Timulak’s [(2007). Identifying core categories of client-identified impact of helpful events in psychotherapy: A qualitative meta-analysis. Psychotherapy Research, 17, 305–314] meta-synthesis of significant events research. Comparisons were made between the types of impacts reported as helpful by clients receiving cognitive behavioural therapy (CBT) or relational integrative counselling. Seventy-five clients identified 291 significant events on 216 Helpful Aspects of Therapy (HAT) forms. The findings broadly reflect all nine impacts identified by Timulak (2007). The study also suggests that a potential new category, ‘voicing’ may exist. Differences between the types of impacts reported as helpful by clients in CBT and integrative therapy showed a higher percentage of CBT clients reporting ‘behavioural change/problem solution’, ‘reassurance’ and ‘client involvement’ as helpful. Differences in other categories were not statistically significant.     

Freiwilligkeit oder Zwang

Within Quasi-Compulsory Treatment (QCT) measures for drug dependent offenders, a variety of treatment measures is offered in place of punishment. The present study examines if coerced clients differ from voluntary clients regarding drug history, criminal behaviour, psychological and medical problems as well as their treatment motivation. The data of the present study have been collected in six different treatment institutions in Austria within the framework of the European research project ?QCT-Europe“. A total of 150 clients, who began treatment either ‘voluntarily’ or as a QCT-measure, has been interviewed using standardized questionnaires. The comparison between ‘voluntary’ and QCT-clients suggests that ‘voluntary’ clients seem to suffer more from medical problems and also show more hazardous drug use behaviour.     

Young clients' narratives of the purpose and outcome of counselling

This study explores how adolescent clients construct the purpose and outcome of counselling. A narrative analysis was performed on interviews with 22 clients (aged 16–18) who had used a school-based counselling service. The aim was to identify the purpose and outcomes that participants attributed to their counselling experience. The analysis identified four narrative forms that young clients used to describe counselling. These included ‘transformative’, ‘supportive’, ‘pragmatic’ and ‘disappointed’ narratives. Each narrative form constructed a different purpose and outcome for counselling. Engaging with clients' narratives about the purpose and intended outcome of counselling may allow counsellors to better match their expectations and approach to fit with their young client or to work with them to co-construct more flexible narratives that support helpful outcomes.     

Reasonable Partiality in Professional Relationships

First, two aspects of the partiality issue are identified: (1) Is it right/reasonable for professionals to favour their clients’ interests over either those of other individuals or those of society in general? (2) Are special non-universalisable obligations attached to certain professional roles? Second, some comments are made on the notions of partiality and reasonableness. On partiality, the assumption that only two positions are possible – a detached universalism or a partialist egoism – is challenged and it is suggested that partiality, e.g. to family members, lies between these two positions, being neither a form of egoism, nor of impersonal detachment. On reasonableness, it is pointed out that ‘reasonable’ is an ambiguous concept, eliding the notions of the ‘morally right’ and the ‘rational.’ Third, a series of practical examples are taken from counselling, medicine, law, education and religious practice and some common principles are abstracted from the cases and discussed. These include truth-telling, confidentiality, conflicts of interest between clients and particular others and between clients and society. It is concluded that while partiality can be justified as a useful tool in standard cases, particular circumstances can affect the final verdict.     

Inviting passage to new discourse: ‘Alive moments’ and their spiritual significance

Some social constructionists assert that therapeutic change occurs when clients' meanings for problems and solutions shift from those found in resource‐impoverished discourses to those affording resourceful and preferred possibilities. Referred to as ‘positioning theory’, our research examined this assertion by inviting clients and therapists to speak of a significant, but ambiguous, experience in unfamiliar discourse: spiritual discourse. Clients were asked to review videotapes of their sessions, selecting moments that felt most ‘alive’ to them for discussions with the researcher, including inquiries as to whether ‘alive’ moments held any spiritual significance. The outcomes are portrayed as a ‘poetic collaboration’ between the researcher, clients and therapists — while clients' and therapists' reported experiences for changes in discourse and meaning are highlighted. Implications regarding sensitivities required when co‐constructing meanings for ambiguous but significant experiences in therapy are discussed. Possibilities for more research examining poetic practices and processes in therapy are also considered in terms of positioning theory.     

The effects of meeting a family therapy supervision team on client satisfaction in an initial session

Despite the wide use of live supervision in marriage and family therapy training, there have been no randomized trials comparing different variations of the practice. This randomized trial of 86 clients was designed to measure client satisfaction after an initial therapy session under two conditions: meeting the supervision team behind the observation mirror or not meeting the team. A mixed linear model analysis of covariance was used to examine the relationship between ‘meeting the team’ versus ‘not meeting the team’ and client satisfaction. There were no statistically significant differences in client satisfaction based on whether clients met the team or not. There was a trend toward greater satisfaction with the therapy session among clients who did not meet the supervision team.     

The Growth of Alternative Therapy: A Valid Argument against the Secularisation Thesis?

The fact that alternative therapy has experienced vast growth during the last 30 years in most of the West is used by both Paul Heelas and Linda Woodhead as an argument against the secularisation theory. The objective of this article is to examine whether such an argument can be seen as being valid. In order to do this, four preconditions are formulated whose fulfilment I consider to be necessary if the above-mentioned arguments against the secularisation theory are to be accepted. The four preconditions are discussed; they are as follows: 1) alternative therapy is of significant magnitude; 2) the alternative therapists themselves consider the practice to be spiritual; 3) the clients seeing such ‘spiritual’ therapists have a spiritually informed motive to do so; 4) ‘spirituality’ as understood both by practitioners and by clients has ‘religious’ connotations.     

Positive CBT: From Reducing Distress to Building Success

Recent decades have witnessed the development of competency-based, collaborative approaches to working with clients. This article reveals how cognitive behavioral therapy (CBT) becomes Positive CBT, with a shift in the focus of therapy from what is wrong with clients to what is right with them, and from what is not working to what is. The concept of Positive CBT, aimed at improving the well-being of clients and their therapists, draws on research and applications from Positive Psychology and Solution-Focused Brief Therapy. A FBA of exceptions to the problem and the ‘upward arrow’ instead of the ‘downward arrow’ technique are two of the many practical applications of Positive CBT, described in this article. Further research is necessary due to its recent development.     

Making the shift from ‘addict self ’ to ‘spiritual self ’: Results from a Stage I study of Spiritual Self-Schema (3-S) therapy for the treatment of addiction and HIV risk behavior

A manual-guided intervention, Spiritual Self-Schema (3-S) therapy, for the treatment of addiction and HIV risk behavior is being developed in a Stage I behavioral therapies development project. 3-S therapy integrates a cognitive model of self with a non-sectarian Buddhist framework suitable for people of all faiths. Data are presented on a sample of 29 cocaine- and opioid-dependent clients. Seventy-nine percent completed the 8-week intervention. Drug use and other HIV risk behaviors decreased with treatment. Evidence of a shift in self-schema from ‘addict self?’ to ‘spiritual self?’ is presented. Reaction time to endorse spiritual qualities as ‘me’ and addict qualities as ‘not me’ decreased, and self-report of daily spiritual experiences and practices, and the perceived influence of spirituality on behavior increased. A shift in self-schema was correlated with change in drug use and other HIV risk behaviors.     

The impact of organisational change on professionals working within a Community Mental Health Team (CMHT): a psychodynamic perspective

The aim of this study was to explore the effects of organisational change upon staff working in a Community Mental Health Team (CMHT). A grounded theory methodology was employed to analyse data from eight interviews with a range of staff. Analysis identified one core category and five key categories. ‘Corrosion of good work: an ethos in decline’ represents the core category and refers to the staff members’ sense of demoralisation of their professional values and integrity. The first key category, ‘Cultural change’, refers to staff members’ perception of change within the CMHT, with an increased emphasis on regulation, performance management and proceduralisation. Three further key categories were identified: ‘Caring clinicians and uncaring managers’, ‘Confusion regarding professional roles’ and ‘Disconnecting and isolating’. The fifth key ‘Staff departing and increasing risk for clients’, describes the impact of the working culture. These categories and emerging theory were interpreted through a psychodynamic lens, and identified the need for better management practice, support, training and supervision of staff as the foundations of safe practice.